NOSOCOMIAL SPREAD OF HUMAN IMMUNODEFICIENCY VIRUS-RELATED MULTIDRUG-RESISTANT TUBERCULOSIS IN BUENOS-AIRES

A steep upsurge of human immunodeficiency virus (HIV)-associated multi drug-resistant tuberculosis (MDR-TB) was recently observed at a referr al treatment center in Buenos Aires City. Between January 1994 and Jun e 1995, TB isolates resistant to at least five drugs were recovered fr om 101 of 272 HIV-infected inpatients. Highly resistant isolates from 77 patients underwent restriction fragment length polymorphism study w ith IS6110. After cross-contamination was eliminated, a single TB stra in was found to have caused disease in 68 patients with a history of o n-site exposure. The frequency of smear-positive pulmonary disease was higher among these patients than among non-MDR-TB HIV-infected patien ts (50/68 vs, 60/148, P < .001), and the 1-year survival was dramatica lly reduced (5/68 vs, 92/148). The strain involved in the outbreak was traced back to patients hospitalized in 1992. Institutional infection control policies were and may still be inadequate to contain the spre ad of TB among immunodepressed subjects, as is the case in other large urban hospitals in Argentina.